Laryngeal Hypersensitivity Diagnosis and Treatment

Introduction to Laryngeal Hypersensitivity

The American Academy of Otolaryngology-Head and Neck Surgery recommends laryngoscopy before prescribing antireflux medication for isolated laryngeal or burning mouth symptoms, to document current laryngeal findings and exclude alternative diagnoses 6, 3

The American Academy of Otolaryngology-Head and Neck Surgery suggests that laryngoscopic findings alone have sensitivity and specificity less than 50% for LPR diagnosis and may be present in healthy individuals 3, 5
Patients with typical GERD symptoms should undergo aggressive lifestyle modifications plus high-dose PPI therapy, with expected response in 4-8 weeks for GI symptoms and up to 3 months for laryngeal symptoms 3, 4

The American College of Gastroenterology recommends considering laryngeal hypersensitivity as the primary diagnosis rather than refractory reflux after one failed 3-month trial of appropriate therapy 1, 2
Neuromodulators like gabapentin may reduce symptoms contributed by laryngeal hypersensitivity and hypervigilance, with a relative risk of 1.28 and 95% CI 0.94-1.74 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery advises against continuing empiric PPI therapy beyond 3 months without objective response, and against adding H2-receptor antagonists to twice-daily PPI therapy for refractory symptoms 3, 4
The American College of Gastroenterology suggests considering Laryngeal Recalibration Therapy (LRT) for patients with chronic laryngopharyngeal symptoms, with 85% of patients experiencing symptom response regardless of proven GERD on objective testing 1, 2